Student Protocol for the Operating Room Vangie Dennis, RN, CNOR, CMLSO
Objectives To observe and gain an understanding of the patient s surgical process experience. To have an understanding of the surgical team environment and the roles each member plays. A basic understanding of the areas in surgery: restricted, semi-restricted & unrestricted and requirements of each.
Objectives Basic understanding of the hazards in the peri-operative environment and ways to protect yourself during observation. Basic understanding of traffic flow in the OR to maintain the sterile field.
Surgical Services Team The Surgical Services team consists of the: Sterile team: Surgeon Surgical assistant Scrub personnel. Unsterile team: Anesthesia: MD/CRNA/PA Circulator Others.
Staff Registered nurse: RN Scrub: RN or CST First assistant: RN Unlicensed assistive personnel Surgical technologist Nursing assistant/orderly Housekeeping Instrument technician Central sterile staff Support staff Surgical scheduler Desk coordinator
Surgical Suite Traffic Patterns The OR is divided into three areas for staff and visitors: Unrestricted Semi-restricted Restricted
Surgical Suite Traffic Patterns Unrestricted Area Street clothes are permitted in this area. Traffic is not limited. This area is isolated by doors from the main hospital door corridor. This area permits access for communication with department and hospital personnel. Examples include: Locker rooms. Surgical scheduling office. Operating room supervisor s office.
Surgical Suite Traffic Patterns Semi-Restricted Area Traffic is limited to properly attired personnel. You must wear scrub attire and caps in this area. This area includes the support areas of the surgical suite. Examples include: Corridors outside the OR. Storage areas for clean and sterile supplies. Clean cores and sub sterile rooms as designated by the facility.
Surgical Suite Traffic Patterns Restricted Area Appropriate OR attire required. You must wear scrub attire, caps and masks in this area. Includes areas where procedures are performed and where there are unwrapped sterile supplies. Examples include: Operating room. Procedure room. Scrub area. Clean cores and sub sterile rooms as designated by the facility.
Operating Room Areas Preoperative (Preop/Holding) Where patient is prepared for the OR Intraoperative (OR Suite) Where the operative procedure is done Postoperative (Recovery/PACU) Where patient recovers from surgery and anesthesia Support areas Where surgical instruments are prepared Areas of patients rooms
Operating Room Areas, cont. Sterile/Central Processing Where sterile instruments are prepared Outpatient and Inpatient Department Patient care areas Patient units Where patient rooms are located
Invasive Departments Invasive departments are areas within the hospital that support our patient care. Examples include: Endoscopy. Lithotripsy. Cardiac catheterization. Lab and electro physiology. Imaging.
Appropriate OR Attire Don clean, fresh OR attire each time on arrival in the OR suite and as necessary when attire is soiled. Change masks between patients and whenever mask becomes wet or soiled. Keep fingernails short and clean. Cover hair and keep it contained within head cover.
Appropriate OR Attire, cont. Do not wear artificial nails. If you wear a cloth hat, it must be laundered daily. Never hang masks loose around your neck.
Appropriate OR Attire, cont. Proper attire for the OR includes: OR scrubs (shirt and pants) Cover jacket Shoe covers Eye protection Hair covers Personnel protective equipment (PPE)
OR Clothing Tips Wear comfortable shoes. Do not wear personal scrubs or reusable head covering. Before leaving the OR for the day, change back into your street clothes. Place used scrub attire into the appropriate receptacle for laundering.
Additional Tips Wear only necessary jewelry. Wear minimal make-up. Dot not wear perfume or cologne. Do not chew gum. Always wear name badge.
Additional Tips Eat Breakfast! Not just toast, something with protein that will last. If you feel faint, light headed or very warm, please tell someone. It is fairly common for students to have a fainting spell. We will take you some where private until you feel better, then you will return to the room.
Chemical Hazards in the OR Chemical hazards associated with the OR include: Anesthetic gases Cleaning agents Formaldehyde Bone Cement (methyl Methacrylate)
Chemical Hazards in the OR If there is ANY chance that you might be pregnant you must leave the room prior to the start of the mixing of the bone cement. These fumes are strong and contain carbon monoxide, hydrogen and methane. It is your responsibility to protect your self. Please tell the clinician, or the charge nurse. No one else needs to know.
Biological Hazards in the OR Biological hazards associated with the OR include: Patient Pathogens Latex sensitivities Cuts and needle sticks Surgical smoke Infectious wastes Radiation exposure.
Patient Pathogen Hazards Blood and body fluids: Blood Pericardial Spinal Saliva Dental procedures Synovial Semen Urine Airborne: Tuberculosis Other: VRE, MRSA Vaginal secretions Pleural Peritoneal Amniotic fluid Non-intact mucous membranes or any other visibly contaminated with blood.
Transmission of Infections Three elements must be present for an infection to occur: 1. An infectious agent 2. Transmission from one person to another 3. A susceptible host
Routes of Transmission Routes of transmission of infection include: Accidental injury that results in a puncture or cut of the skin by a sharp object soiled with infectious material. Infectious material contacting: Open cuts Nicks Skin abrasions Dermatitis. Exposure of mucous membranes eyes, nose, mouth to infectious material.
Routes of Transmission, cont. Routes of transmission, continued: Touching an object soiled with infectious material and then indirectly transmitting the infectious material to your: Eyes Nose Mouth Open skin lesion. Casual contact with infected patients does not cause infection.
Barriers to Transmission of Infection Hand washing is your best defense against transmission of infection!
Barriers to Transmission of Infection Use of PPE: Gloves Gowns Masks Hair covers Eye protection
Principles of Asepsis Asepsis is the absence of diseasecausing microorganisms. Aseptic technique: Uses methods of preventing contamination from microorganisms. Is used to achieve a sterile environment.
Sterile Field, Defined A sterile field is defined as the areas that surround and include the surgical site in which aseptic/sterile technique must be maintained.
OR Sterile Area The sterile area in the OR includes: Back table Mayo stand Surgical team OR bed with sterile drapes Draped radiological equipment.
Sterile OR Technique Principles of sterile OR technique: Scrub person functions within the sterile field. Use sterile gowns and gloves within the sterile field. Use sterile drapes to establish a sterile field.
Sterile OR Technique, cont. Open, dispense and transfer all items introduced onto the sterile field by methods that maintain sterility and integrity. Gowns are sterile only: From the chest to the level of the sterile field in the front, and From 2 inches above the elbows to the cuffs on the sleeves. Sterile persons should sit only when the entire procedure will be performed at this level.
Sterile OR Technique, cont. Consider sterile barriers contaminated after penetration. Consider the edges of a sterile package or container contaminated after opening. Sterile persons touch only sterile items. Non-sterile persons touch only nonsterile items.
Monitoring the Sterile Field Monitor the sterile field constantly. Prepare as close to use as possible. Constantly observe field. Do not cover sterile fields. Keep conversation to a minimum. Secure surgical equipment to the field.
Moving within a Sterile Field When moving within or around a sterile field, do so in a manner to maintain the sterility and integrity of the field. Scrubbed persons stay close to the sterile field. Move from sterile area to sterile area. Avoid changing levels. Pass back-to-back or front-to-front. Un-scrubbed persons face the sterile field at all times. Do not walk between two sterile areas. Minimize number of people in the OR.
Protecting the Patient To protect the patient: Wear correct OR attire. Use sterile drapes when doing surgery. Limit traffic in and out of the OR rooms. Decrease growth of pathogens in room by maintaining: Proper temperature, Ventilation, and Humidity in room.
Our Patients are Our First Priority Direct all attention toward the patient. We in the OR work as a team to ensure the most positive outcome for the patient. All of us are accountable for our actions while in the surgical arena.
Congratulations! You have completed this CBL module. To continue, click on & complete the Acknowledgement Form. Surg Techs also complete the Checklist. Questions? Contact: Brenda Yates RN, BSN, MBA, CNOR 678-312-6657 Byates@gwinnettmedicalcenter.org